M4M Cat Adoption Application

Mountaineers For Mutts (M4M) Cat Adoption Application

Date *

Month Day Year

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

E-mail *

Employer *

The cat I am interested in is:

Cat Name *

Breed *

I want to *

Foster this cat Adopt this cat

Do you have any other pets at home? *

Yes No

Current pets?

Dog(s) Cat(s) Bird(s) Small & Furry

How many of each do you have?

Please list your current pets and additional information about them below.

Dog 1 Name and Age:

Dog 1: Altered?

Yes No

Dog 1: Current on these vaccinations:

Rabies Distemper/Parvo combo Lyme Bordetella

Dog 1 lives

Indoors Outdoors Indoors/Outdoors

If you have more than one dog, please list the others here: name, age, altered, current on vaccinations & where does it live? *

Cat 1 Name and Age

Cat 1 Altered?

Yes No

Cat 1: Current on these vaccinations:

Rabies Combo Vax

Cat 1 lives

Indoor only Outdoor only Indoor/Outdoor We have a cat door so cat is free to come/go

If you have more than one cat, please list the others here: name, age, altered, current on vaccinations & where does it live?

Have you had other animals as pets in the past?

Yes No My parents had them when I was a child, but I haven't yet had my own as an adult.

If yes, what happened to them?

Veterinarian Name *

Veterinarian Phone *

Veterinarian City & State *

Do you own or rent? *

Own Rent

If you rent, does your lease allow pets? *

Yes No Not applicable. I own my home.

Renters please list landlord name

Renters please list landlord phone

Do all the adults in your household know you plan to adopt? *

Yes No

Are there children in the home? *

Yes No

Ages of children?

Does anyone in your household have any known allergies to animals?

Yes No

Are you financially prepared to give this cat routine and emergency medical care?

Yes No